Organization
ABYSSINIA DENTAL LLC
Active
Other names
Abys Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DEREJEW KIFLE TESSEMA DDS (DENTIST)
(301) 477-1005
Entity
Organization
Contact information
Practice address
4041 POWDER MILL RD STE 100, BELTSVILLE, MD 20705-3106
(301) 477-1005
Mailing address
4041 POWDER MILL RD STE 100, BELTSVILLE, MD 20705-3106
(301) 477-1005
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
131458100
—
MD
05
—
17075979
—
DC
Enumeration date
11/29/2018
Last updated
11/29/2018
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